88. The Chairman reminded the Committee that the 23rd Session of the Codex Alimentarius Commission returned the Proposed Draft Revised Standard to Step 3 for further comments and consideration by this Committee.
89. The Representative of WHO referring to its written comments presented in document CX/NFSDU 00/7 informed the Committee that the WHO recommended that infants and children be fed exclusively on breast milk for four to six month of life and thereafter they should begin receiving nutritionally adequate and safe complementary foods, while continuing to breastfeed for up two years of age or beyond.
90. The Representative indicated that the WHO s recommendation was the subject to continual review, was based on the best available scientific and epidemiological evidence and that an age range was an intrinsic element of this population-based recommendation. He indicated that meeting the nutritional need of the individual infant, consistent with the above recommendation, should be accomplished in the light of the individual infant s specific circumstances.
91. The Representative indicated that it was essential that instructions on the recommended age of use of products covered by the Draft Revised Standard respect both the upper and the lower end of the 4 - 6 month age range. He pointed out that in order to ensure that WHO s infant-feeding recommendation continue to reflect the most up-to-date globally applicable scientific and epidemiological evidence, a systematic review of relevant scientific literature was undertaken and that the results of would be available next year. It was pointed out that WHO s multicentre growth reference study was under way in six countries involving more than 10000 children and that this study will contribute to improved understanding of the age range during which breast milk alone was sufficient to meet the healthy infant s nutritional requirements. He indicated that the results would be available by the year 2003.
92. The Representative placed emphasis on three additional issues relevant to WHO s infant-feeding recommendation and the work of this Committee:
-firstly the WHO trusted that this Committee would adopt positions, reflecting the evidence-based recommendations of its parent organizations, and that if the weight of scientific and epidemiological evidence was changed, the relevant provisions of any related Codex standards would also be changed accordingly;93. The Delegation of India strongly opposed the reference to the age from four to six months in view of current scientific evidence and expressed concern at the statement of the WHO Representative. The Delegation recalled that for these reasons the Standard was not adopted at Step 5 by the 23rd Session of the CAC and was returned for further consideration by this Committee. The Delegation pointed out that the early introduction of complementary feeding undermined the invaluable advantages of breast-feeding and increased risks to infants health. The Delegation also pointed out that since the standard was a world-wide one it was essential to take into consideration the requirements of infants and children in developing countries recognizing that early introduction of complementary foods could have serious implications on their morbidity and mortality.-secondly, there were Member governments that adopted more stringent measures with the recommended age to start of complementary feeding and this country-specific approach was endorsed by the WHO; and this possibility is explicitly provided for in the last sentence in para 8.5.4 of the Proposed Draft Revised Standard. However in the context of a Codex Standard the current population-based world-wide infant feeding recommendation should be reflected; and
-thirdly, it was essential for products labels and related information materials to scrupulously observe both the lower and the upper end of the recommended age range for exclusive breast feeding and therefore for the Draft Revised Standard on cereal-based foods the following wording should be adopted:
The label shall clearly state that the product is recommended for use from age of about 6 months and not before 4 months
94. A number of delegations proposed that the consideration of the age range be deferred until the findings of the WHO research were available. Several Delegations stated that they did not agree with the proposal of waiting for the outcome of WHO studies since that would not alter the nature of the issue, and ample scientific evidence supported the introduction of complementary feeding of about six month.
95. The Representative of UNICEF confirmed that the review of the scientific literature, that is being currently undertaken by WHO, would provide clarification with regard to the age of introduction of complementary foods early in 2001. The Representative further clarified the difference between the Multicenter Growth Reference Study, which will lead to creation of a new growth curve, and the review which is based on the existing scientific evidence.
96. The Mexican Delegation stated that the WHO Multicentre Growth Reference Study will provide important data for an anthropometric references, but that it could not be conclusive for the recommendation of the duration of exclusive breast feeding since other important factors such as the inconvenience of an early exposure of infants to gastrointestinal and respiratory infections and the impact of exclusive breast feeding in the fertility regulation in populations should be taken into account.
97. The Delegation of Brazil indicated that its written comments did not reflect its current position and should be disregarded and stated that the age of introduction of cereal-based foods for infants and children should be at about 6 months and that it would be in consistency with their national policy. The Delegation indicated that it would be in line with many UNICEF and WHO publications, and that cohort study carried out in Brazil showed that infants from 3 to 5.9 months receiving breast and complementary feeding were 3.4 times more likely to be admitted in hospitals for pneumonia then were those who received breast milk alone. The Delegation questioned the applicability of WHO Multicentre Growth Reference Study to the debate on the age of introduction of complementary feeding.
98. The Chairman drew the attention of the Committee to the fact that consensus could not be reached on this sensitive issue at this stage and suggested to keep the current wording 4 to 6 months of the Scope in square brackets.
99. The Delegation of Ghana supported retaining square brackets on the age of introduction in the Scope and indicated that Ghana followed WHA Resolution 47.5 in which the age of introduction of complementary feeding practices was from about of age of 6 months. The Delegation was in favour of further considering the Proposed Draft Revised Standard. This view was supported by the Delegations of Botswana, Tanzania and Kenya.
100. The Observer from IBFAN proposed to put the two provisions "4 to 6 months" and "about six month" in square brackets to reflect the whole discussion.
101. The Delegation of India recalled that the Commission had returned the Proposed Draft to the Committee for further discussion and that full consideration should be given to this important issue. It expressed concern at the inadequate time allowed for consideration of this important Agenda Item.
Status of the Proposed Draft Revised Standard for Processed Cereal-Based Foods for Infants and Children
102. The Committee recognized that it was not possible to reach consensus on the fundamental issue of the Scope at this stage and that it would not be possible to make further progress on the revision at the current session. The Committee therefore agreed to retain the Proposed Draft Revised Standard at Step 4 for further consideration at the next session and ask the Commission how to proceed with this issue.
